Hu Emily A, Kelley Tommy, Haryani Ajay
Nourish, New York, NY, United States.
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
JMIR Mhealth Uhealth. 2025 May 6;13:e70228. doi: 10.2196/70228.
Obesity represents a major public health crisis in the United States, imposing substantial health risks and economic costs. Medical nutrition therapy (MNT) is an evidence-based treatment where a registered dietitian provides personalized nutrition and lifestyle guidance to patients. MNT has been demonstrated to be effective for weight loss and managing chronic diseases in patients with obesity. With the rise of telehealth, MNT has gained popularity as an accessible alternative to traditional in-person care. While a nationwide program integrating MNT with a companion mobile app offers a comprehensive weight management solution, data supporting its clinical effectiveness is limited.
This study aimed to evaluate the effectiveness of an MNT program with a companion mobile app on weight loss among adults with overweight and obesity.
This retrospective cohort study included users of Nourish, an MNT program with a companion mobile app, who attended at least 1 appointment between August 2023 and October 2024 and had a baseline BMI≥30 kg/m² or a BMI between 27-30 kg/m² with diabetes or prediabetes. The primary outcome was the proportion of participants who achieved at least 5% weight loss; secondary outcomes included mean weight change, mean percent weight change, and the proportion of participants who achieved at least 3% weight loss. Statistical significance of weight change was determined using 2-tailed t tests. Subgroup analyses were performed by sex, BMI, follow-up time between weights, number of appointments completed, and levels of engagement according to appointment frequency and app usage.
In total, 3951 participants were included in the analysis. The mean age was 38 (SD 10) years, and 78% (3082/3951) of participants were female. Weight loss was reported as a program goal by 70% (2748/3951) of participants, while 31% (1204/3951) and 24% (939/3951) reported diabetes or prediabetes and a cardiovascular condition, respectively. Over a median follow-up of 2.2 months, 17% (689/3951) of participants achieved at least 5% weight loss. The mean weight change was -4.5 (SD 8.9) pounds, corresponding to a mean percent weight change of -2% (SD 3.9; P<.001). Males and participants aged 60 years or older were more likely to experience at least 5% weight loss. Longer follow-up time between weights and a higher number of completed appointments (≥5 appointments) were significantly associated with a significantly higher likelihood of achieving at least 5% weight loss (P<.001 for both). In addition, participants who were most engaged, based on appointment frequency and app usage, were more likely to achieve at least 5% weight loss compared with those who were less engaged (P<.001).
Engagement with an MNT program and companion mobile app is associated with significant weight loss for adults with overweight and obesity and may serve as an effective, scalable weight management solution.
肥胖是美国面临的重大公共卫生危机，带来了巨大的健康风险和经济成本。医学营养治疗（MNT）是一种循证治疗方法，由注册营养师为患者提供个性化的营养和生活方式指导。MNT已被证明对肥胖患者的体重减轻和慢性病管理有效。随着远程医疗的兴起，MNT作为传统面对面护理的一种便捷替代方式而受到欢迎。虽然一个将MNT与配套移动应用程序相结合的全国性项目提供了全面的体重管理解决方案，但支持其临床有效性的数据有限。
本研究旨在评估一个带有配套移动应用程序的MNT项目对超重和肥胖成年人减肥的有效性。
这项回顾性队列研究纳入了使用Nourish（一个带有配套移动应用程序的MNT项目）的用户，这些用户在2023年8月至2024年10月期间至少参加了1次预约，且基线BMI≥30kg/m²，或BMI在27 - 30kg/m²之间且患有糖尿病或糖尿病前期。主要结局是体重减轻至少5%的参与者比例；次要结局包括平均体重变化、平均体重变化百分比，以及体重减轻至少3%的参与者比例。使用双尾t检验确定体重变化的统计学显著性。根据性别、BMI、两次称重之间的随访时间、完成的预约次数以及根据预约频率和应用程序使用情况的参与程度进行亚组分析。
总共3951名参与者被纳入分析。平均年龄为38（标准差10）岁，78%（3082/3951）的参与者为女性。70%（2748/3951）的参与者将体重减轻作为项目目标，而分别有31%（1204/3951）和24%（939/3951）的参与者报告患有糖尿病或糖尿病前期以及心血管疾病。在中位随访2.2个月时，17%（689/3951）的参与者体重减轻至少5%。平均体重变化为 - 4.5（标准差8.9）磅，对应平均体重变化百分比为 - 2%（标准差3.9；P <.001）。男性和60岁及以上的参与者更有可能体重减轻至少5%。两次称重之间更长的随访时间和更高的完成预约次数（≥5次预约）与体重减轻至少5%的可能性显著更高显著相关（两者P <.001）。此外，根据预约频率和应用程序使用情况，参与度最高的参与者与参与度较低的参与者相比，更有可能体重减轻至少5%（P <.001）。
参与MNT项目和配套移动应用程序与超重和肥胖成年人的显著体重减轻相关，可能是一种有效、可扩展的体重管理解决方案。
